PrEP IN THE WILD

GT (UK) - - COMMUNITY - MATTHEW HOD­SON, OUT­GO­ING CHIEF EX­EC­U­TIVE OF GAY MEN’S HEALTH CHAR­ITY GMFA, @MATTHEW_HODSON

Ev­ery year, more than 2,500 gay and bi­sex­ual men be­come in­fected with HIV. Trans women and other groups also carry a high bur­den of HIV in­fec­tion. If you have the virus, you have it for life. You’ll need to take med­i­ca­tion to keep you alive. You’ll need to be mon­i­tored by clin­i­cal ser­vices. HIV is no longer the death sen­tence it once was, but it is still a life sen­tence.

PrEP stands for PreEx­po­sure Pro­phy­laxis, which means it’s a pre­ven­tion that you take in ad­vance. When taken cor­rectly, PrEP HIV pre­ven­tion than other meth­ods – in­clud­ing con­doms. On its own, PrEP wouldn’t reach enough peo­ple to end HIV, but com­bined with con­tin­ued con­dom use, and an ex­pan­sion of the suc­cess we’ve seen in get­ting peo­ple di­ag­nosed ear­lier and treated, the end of HIV is at least in sight.

With­out PrEP be­ing avail­able on the NHS, some gay men have taken it upon them­selves to get their hands on the pills. A month’s sup­ply of Tru­vada, the drug ap­proved for PrEP, costs about £400, although cheaper generic ver­sions are also avail­able, at about 10% of that cost. It’s le­gal to im­port these drugs for per­sonal use.

But un­like con­doms, PrEP doesn’t pre­vent other STIs, which makes it even more im­por­tant that any­one on PrEP gets checked reg­u­larly so that any other in­fec­tions can be de­tected quickly, and treated. There’s a dan­ger that by forc­ing peo­ple to ac­cess PrEP ‘in the wild’ those cru­cial links with sex­ual health ser­vices are sev­ered, in it­self con­tribut­ing to poorer sex­ual health. Also, while the ma­jor­ity of peo­ple who take it can have an im­pact on your kid­neys and bone den­sity, which is why it’s vi­tal that peo­ple on PrEP get mon­i­tored, in the same way as peo­ple tak­ing the same drugs to treat HIV are mon­i­tored.

HIV pre­ven­tion or­gan­i­sa­tions and med­i­cal bod­ies – in­clud­ing GMFA, THT, NAT, NAM, LGBT Foun­da­tion, BHIVA and BASHH – are united in call­ing for PrEP to be made avail­able. We don’t want ev­ery­one to be put on PrEP. How­ever, there are a num­ber of peo­ple – many of them gay men – who by their be­hav­iour are clearly on the path to ac­quir­ing HIV.

In the era of chem­sex, it has be­come even more of a chal­lenge to change pat­terns of un­safe sex­ual be­hav­iour. You can be a staunch ad­vo­cate of con­doms, but un­less you have some magic wand, you’re not go­ing to be able to con­vince ev­ery­one to use con­doms all the time. The in­creas­ing pre­ven­tion chal­lenge is played out against a back­drop of di­min­ish­ing fund­ing for pre­ven­tion, a pat­tern we’ve seen ever since the 80s.

PrEP isn’t a magic bul­let, but com­bined with other pre­ven­tion tools we could down to a level where we’d soon see it die out. To do this would re­quire PrEP be­ing great­est risk of ac­quir­ing HIV, and not just those who can sav­ings on treat­ment and care for peo­ple liv­ing with

We have the tools we need to end HIV. Just imag­ine how great that would be. Then

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